The word “cancer” strikes fear in everyone who is told they have it. It conjures up images of a fast-moving, life-threatening disease.

That isn’t necessarily the case for men with newly diagnosed prostate cancer. More than half of them have a type of cancer that is confined to the prostate gland and that grows so slowly it will never affect their health or their lives. Yet almost 90% of men told they have prostate cancer opt for immediate treatment with surgery or radiation therapy—which often cause trouble getting or keeping an erection and an assortment of urinary problems.

Two weeks ago, a panel of experts convened by the National Institutes of Health recommended that many men with localized, low-risk prostate cancer be closely monitored, and that treatment be delayed until there was evidence that the disease was progressing.

“It’s clear that many men would benefit from delaying treatment,” Dr. Patricia A. Ganz, conference panel chairperson and director of the Division of Cancer Prevention and Control Research at the Jonsson Comprehensive Cancer Center at the University of California in Los Angeles, said in a statement, adding that Read more »

This interview is the ninth and final of a series of brief chats between CFAH president and founder, Jessie Gruman, and experts—our CFAH William Ziff Fellows—who have devoted their careers to understanding and encouraging people’s engagement in their health and health care.

Trudy Lieberman is concerned that despite all the rhetoric, choosing the best hospital, the best doctor, the best health plan, is simply not possible. Some of the so-called best might be good for some people but not others, and the information available to inform/guide choices is just too ambiguous.

Irrational exuberance was a term once used to describe the stock market before the last crash. It also seems an apt description for much of the talk these days about empowered health consumers.

To be sure, patients today have unprecedented access to health information. Patient decision-support tool can be found on just about every provider, payer and self-insured employer website. Consumers can go to any number of websites to find quality data about hospitals, physicians and health plans. Personal health records (PHRs) promise to make our personal health data portable for meaning that all our treating physicians will be “singing off the same song sheet.”

That’s what the industry experts tell us. But what’s really going on? Here I will describe what I see as the top 5 myths about empowered health consumers. Read more »

Recently, I had a conversation with Shannon Brownlee (the widely respected science journalist and acting director of the Health Policy Program at the New America Foundation) about whether men should continue to have access to the PSA test for prostate cancer screening, despite the overwhelming evidence that it extends few, if any, lives and harms many more men than it benefits. She felt that if patients could be provided with truly unbiased information and appropriate decision aids, they should still be able to choose to have the test (and have it covered by medical insurance). Believing that one of the most important roles of doctors is to prevent patients from making bad decisions, I disagreed.

After reading Your Medical Mind, the new book by Harvard oncologist and New Yorker columnist Jerome Groopman, I think he would probably side with Brownlee’s point of view. Groopman, whose authoring credits include the 2007 bestseller How Doctors Think, and wife Pamela Hartzband, MD have written a kind of sequel to that book that could have easily been titled How Patients Think. Drawing on interviews with dozens of patients about a wide variety of medical decisions – from starting a cholesterol-lowering drug, to having knee surgery, to accepting or refusing heroic end-of-life interventions – the authors Read more »

My hat goes off to kiddy shrinks. It’s a tough field, full of issues we don’t see in adult psychiatry.

Our comment section often buzzes with talk about the over-diagnosis of bipolar disorder in children and the ethics of giving psychotropic medications to children. The Shrink Rappers never comment on these things. Why? Because we don’t treat children. I have no idea if the children being treated are mis-diagnosed, over-diagnosed, wrongly-diagnosed, or if the increase in treatment represents a good thing—- perhaps children who would have suffered terribly now are feeling better due to the option of medications. I’ve certainly had adult patients tell me their children were treated with medications, the children have often eventually stopped the medications and emerged as productive adults. Would they have outgrown their issues anyway. Or did the treatment they received switch them from a bad place to a good place and enable them to carry on in a more adaptive way? Ugh, my crystal ball is on back-order at Amazon!

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